Provider Demographics
NPI:1770583007
Name:STANSBERRY, JUDITH O (LPC/MHSP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:O
Last Name:STANSBERRY
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50834
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-0834
Mailing Address - Country:US
Mailing Address - Phone:865-938-4381
Mailing Address - Fax:865-938-4382
Practice Address - Street 1:109 STEKOIA LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-1608
Practice Address - Country:US
Practice Address - Phone:865-938-4381
Practice Address - Fax:865-938-4382
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000000680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1221702OtherCHA HEALTH
TN359712OtherMHN
TN7679319OtherAETNA
TN270035000OtherMAGELLAN
TN501106OtherVALUE OPTIONS
TN620547289R2OtherJOHN DEERE HERITAGE
TN245446OtherUNITED BEHAVIORAL HEALTH
TN247699OtherCOMPSYCH
TN4251971OtherBCBS
TN1065067OtherCIGNA